Provider Demographics
NPI:1306039326
Name:WEIR, JAALA DANIELLE
Entity type:Individual
Prefix:
First Name:JAALA
Middle Name:DANIELLE
Last Name:WEIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAALA
Other - Middle Name:DANIELLE
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25500 PORTOLA LOOP
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2235
Mailing Address - Country:US
Mailing Address - Phone:909-810-7263
Mailing Address - Fax:
Practice Address - Street 1:9707 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3609
Practice Address - Country:US
Practice Address - Phone:951-358-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1230631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical